This copy is for your personal non-commercial use only. To order presentation-ready copies of Toronto Star content for distribution to colleagues, clients or customers, or inquire about permissions/licensing, please go to: www.TorontoStarReprints.com

A CFL star’s brain and how it can help you

By Mary OrmsbyFeature Writer

Fri., Nov. 23, 2012

Toronto Argonaut Ted Toogood was racing towards the Winnipeg end zone at Varsity Stadium when two grimy hands clamped around his neck.

The 1950 Grey Cup was on the line. The speedy Toogood had the ball. A hulking dirt-caked Blue Bomber stopped him — by yanking the Argo’s helmet to the right. Was this one of the plays that injured Toogood’s brain?

Billions of neurons – vital message-carrying brain cells – are vulnerable to damage from such a split-second torque of the head and neck. Dying neurons spill insoluble proteins that clump together like toxic time bombs, hidden within brain tissue. Unseen until autopsy.

Toogood didn’t miss a down from that whiplash. The halfback was small at five-foot-eight and “155 pounds soaking wet” but tough, recalls Joan, his wife of 63 years. No hit was too hard.

Six decades later, Ted Toogood’s brain tells a different story.

ARTICLE CONTINUES BELOW

An autopsy confirmed the 86-year-old Toogood, ravaged by Alzheimer’s, also had Chronic Traumatic Encephalopathy, or CTE. The degenerative neurological disease is closely linked — often sensationally so — to football players with histories of repeated concussions.

But CTE is not exclusive to football players or athletes. Ted Toogood’s gift to science — his donated brain — is poised to help the broader community, from battered children to injured labourers to the elderly who trip and fall.

“Sports are just the tip of the iceberg, the ones that get into the news,” says Toronto neurologist Charles Tator, who’s leading the ground-breaking Canadian Sports Concussion Project, and lobbying for brains and $25 million with which to study them.

“In Canada we probably have people sustaining at least 30,000 concussions a year, at least — about a quarter of them occur in sports.”

For researchers, athletes provide a convenient population to study, particularly those in collision sports like football. They are at high risk for multiple mild brain injuries.

Toogood was never officially diagnosed with a concussion. Former Argonaut quarterback Matt Dunigan had 12. The television broadcaster suspects he’s sustained dozens more during a football career that started at age 10 and ended after 14 CFL seasons.

“You may get two or three a season that turn things sideways, tilt the field, give you tunnel vision, get you seeing stars or spots,” says the 52-year-old Dunigan, who breaks down action for TSN in the 100th Grey Cup championship Sunday, in Toronto.

ARTICLE CONTINUES BELOW

“When you start adding up the totals, they become a little overwhelming.”

A Canada Post stamp, 678 Roman Catholic nuns, a $10-million machine, 40 living Canadian Football League alumni, 14 medical sleuths and Toogood’s family all play roles in the ongoing detective work to solve CTE’s riddles. And to date, there are very few answers.

“As crazy as it sounds, there is no living evidence of this condition,” Tator says.

Ted Toogood didn’t volunteer to donate his brain. His family made that decision for him while he was still alive.

“This hadn’t come up while he was still cognitive,” says Joan, a witty, engaging 82-year-old, referring to early concussion research conducted on donated brains in Boston.

“I got to thinking Ted would like to think he was living on, you might say, in this way.”

Toogood was a Toronto native who met his future wife when mutual friends set up the two University of Toronto students on a date. They clicked, marrying in 1948.The pair had six children – five girls and a boy – and led an active lifestyle.

“Ted was a great dad. Nothing was too much trouble for Ted,” recalls Joan.

Toogood became a popular high school teacher and coach for football, basketball and track. He was also Ryerson University’s first athletic director.

In his spare time, Toogood taught himself to paint. The bright, tidy Toogood home displays his oil paintings on walls; his portrait of daughter Sharon on a canoe trip is particularly poignant. Sharon died of cancer in November of 2009, five months after her father — who trained as an air force gunner in Halifax near the end of the Second World War — was admitted to Sunnybrook Hospital. Nine years after Toogood was diagnosed with Alzheimer’s disease, Joan could no longer care for her husband alone.

In 2010, NHL tough guy, Bob Probert, died of heart failure at age 45. His brain was donated to the Boston group. In March of 2011, it was confirmed Probert had CTE.

Joan absorbed the stunning Probert news. She then wondered about her husband, in Alzheimer’s deepening grip for a decade, and football’s possible role in his dementia. Toogood had been an old-school, two-way player for about 15 years; at Runnymede Collegiate, U of T, in the military then the CFL for five seasons.

Joan called Tator at Toronto Western Hospital’s Krembil Neuroscience Centre. This information struck her: As CTE can only be diagnosed in death, brains for diagnostic autopsy were desperately needed for study.

Joan was sold. If her husband, indeed, had those signature tau deposits, his stricken brain might provide a road map for medical progress.

Dr. Lili-Naz Hazrati is a neuropathologist. She is, foremost, an Alzheimer’s specialist. She also conducts the project’s autopsies. The doctor needs to know when death occurs so the brain can be retrieved quickly and “gently” Hazrati says, and the body returned to the family.

Joan and Hazrati were in close contact over the last three difficult months of Toogood’s life. He died July 31, 2011.

Hazrati confirmed Toogood, in conjunction with severe Alzheimer’s, also had CTE.

CTE plays a role in that destruction. To what extent — especially in a person who has other ailments like Alzheimer’s, as Toogood did — is contained in whisper-thin layers of brain tissue six microns thick. (A micron is a millionth of a metre.)

When Toogood’s brain was ready for examination, Hazrati’s skilled hands sliced it down the middle to obtain two symmetrical mirror images: left and right halves.

The left side was submerged in formalin to “fix it” for two weeks. Formalin is a clear, diluted 37-per-cent solution of formaldehyde that preserves tissue for microscopic study. The right side was stored in a freezer, at minus-80 C, precious chemical-free material available for future study, says Hazrati.

The left half was cut in a systematic way, with 25 to 30 blocks of material taken from various anatomical regions of the brain.

The brain tissue blocks are sealed into cassettes, embedded in paraffin wax, identified individually by bar codes, then processed in the hospital lab.

About 30 slides will be made from each block. Tissue is sliced into translucent ribbons, bathed in cold water at 4 Cthen transferred onto slides by a technician.

The tissue is stained brown by an immunohistochemistry technique that uses antibodies to bind to areas where tau exists. CTE’s signature tau pattern dappled the upper reaches of Toogood’s brain. Alzheimer’s markers were in another distinct area, tucked low.

Are the two diseases related? Does brain trauma play a role in both, one — or none?

Hazrati says she does not have enough evidence to answer those questions in absolute terms. Not yet. She says that without proof, it’s “irresponsible” to state conclusively that head trauma, like the kind Toogood sustained over his football career, causes CTE or other dementias.

“We just don’t know,” she says.

If Ted Toogood were competing in Sunday’s Grey Cup and was whiplashed as he was 62 years ago, it would be impossible to peer inside his skull, even with today’s cutting-edge technology, to see a concussion.

Concussions are brain injuries that are too subtle for conventional 1.5 or 3-Tesla magnetic resonance imaging (MRI) machines to detect.

Concussions can only be identified by a skilled clinician and an honest, compliant patient. It’s not exact, but neuroradiologist David Mikulis wants to change that — if he can get his hands on a new, $10-million 7-Tesla imaging machine.

Mikulis, one of 14 neuroscientists on Tator’s project, hopes to develop an imaging biomarker to detect concussions and track CTE’s tau proteins. That way, concussions can be identified accurately soon after they occur, and those with repeated concussions and brain degeneration won’t have to wait until autopsy for diagnosis. Early treatments would also be possible.

“There’s a timeline we have to think about; there’s the acute injury, then that injury can evolve over time,” says Mikulis, sitting in a cramped, dark Toronto Western Hospital office, lit screens on a wall behind him.

“What we’d like to see is that the brain heals itself over time. But we think in some patients, the injury is not healing itself, especially if there is repeated head trauma.”

It may also be possible to solve tau’s latency secret.

“That is one of the key questions,” says Tator, in a chair next to Mikulis. “We don’t know if tau gets deposited five minutes after the first concussion or five years after the first concussion or only after repeated concussions.”

Tator describes the international medical community as competitive in the concussion field, searching for eureka moments and “a pot of gold” those moments bring.

Tator needs a $25-million pot of gold.

“We are in a race,” the neurologist says, “and we want to win the race.”

Ted Toogood was in his early 70s when he noticed he was changing.

An early sign: The man who memorized complicated plays on the gridiron couldn’t find his car in a large parking lot without tying a bright red ribbon to the antenna.

“He knew there was something wrong,” says Joan.

Toogood was devastated but accepting when he was diagnosed with Alzheimer’s in 2000, recalls Joan. Her husband’s descent into the incurable disease as relatively slow, which she attributes to nine years of loving care at home.

Toogood, who held a master’s degree in science, was also highly intelligent. Was that a factor in the rate of onset? A remarkable ongoing study suggests it is.

The “Nun Study” began in 1986, using data from School Sisters of Notre Dame living in Mankato, Minn., to research aging and Alzheimer’s disease. As part of the multi-layered project now run by the University of Minnesota, 678 nuns have pledged their brains to science upon death.

Some autopsied brains had severe, pathological features of Alzheimer’s. Yet a number of those nuns showed no clinical signs of it while alive, suggesting the brain’s unaffected, healthy tissue was able to compensate for, or better endure, Alzheimer’s effects.

It’s thought well-developed linguistic skills (essays written when the nuns were young were studied to measure detail, thoughts and emotions) bolster “cognitive reserve” — the brain’s resilience to neurological disease.

It’s a branch of research that has “implications for all of us, healthy or not,” says Robin Green. Green is a Canada Research Chair in traumatic brain injury and a clinical neuropsychologist in the sports concussion project.

Green is searching for CTE facts in the living.

Green, also a senior scientist at Toronto Rehab, is part of a unique longitudinal study of 40 anonymous CFL alumni volunteers. Psychological, neurological and cognitive assessments will develop biomarkers of CTE using two player cohorts: 20 who have had multiple mild concussions or whose football positions (like a defensive lineman or running back) put them at high risk of such, and 20 who have had two concussions or fewer, like placekickers.

About 15 players have undergone examinations and have pledged to remain part of the longitudinal study.

“We are trying to understand who is at risk and why and what are some of the underlying mechanisms of the disease,” Green says.

“When one of these fellows walks through our door and presents with symptoms, we don’t know whether what we’re seeing is the early effects of this disease, CTE, or the enduring effects of a lot of concussions because there are similarities — but in the latter case, it’s not progressive.

“So how do we know which is which? We need some diagnostic tools.”

The study also offers clinical interventions to benefit symptomatic players. Psychiatric manifestations such as depression and anger are among symptoms that may be linked to CTE.

Green's “combination therapy approach” includes cognitive behaviour therapy, goal management training for cognitive issues and environmental enrichment (the latter providing methods to stimulate neuroplastic change in order to protect healthy brain tissue and minimize the course of CTE, where present).

CFL Alumni Association executive director Leo Ezerins, 55, a linebacker in Hamilton and Winnipeg, and former Argonauts Brad Elberg, 41, and Paul Markle, 66, are study subjects. They agreed to be named to encourage more CFLers to volunteer and contribute to what Ezerins calls “the greater good” of community health.

“It’s not the game of football or the game of hockey, it’s really the game of life we’re talking about,” says Ezerins, 55.

“The demographic and the challenges with dementia down the road are going to be huge. CTE is just another diagnosis of dementia.”

It’s estimated six million Canadians have progressive neurological conditions and debilitating brain injuries and disorders.

Sixteen years after Dunigan’s final professional football game, the CFL Hall of Famer (who is on Tator’s advisory board) describes his lingering effects from concussion. Loss of equilibrium. Memory deficits. Some difficulty articulating thoughts. Nausea, periodically. He has mood swings but “I don’t count that one.”

“Even if it was a symptom, I always try to deal with it and control that to some degree and take pride in being even-keeled as much as possible.”

Dunigan is on Green’s waiting list.

A new Canada Post stamp commemorating the Toronto Argonauts’ Grey Cup history is a sanitized depiction of the original black-and-white photograph of Toogood being tackled, head first, in the 1950 Grey Cup.

“Until recently, the first point of contact was the head; you control the head, you control the body,” Ezerins says of the way tackling methods were taught for decades. “That technique’s all gone.”

The stamp, with double-blue legend Michael (Pinball) Clemons in the foreground, also provides a tiny reminder why athletes are a good population for concussion research. They can be identified by sport, position and age. If they are concussed and eventually develop CTE or other neurological diseases, the brain injuries can be pinpointed as a possible causal event — and how and when they occurred.

That type of detailed information is not readily available with non-athletes.

Toogood is one of six CFLers whose brains have been autopsied. The others are Bobby Kuntz, Jay Roberts, Peter Ribbins, Tony Proudfoot and one anonymous donor. All had histories of multiple concussions. All had significant signs of brain disease, but only three had CTE.

Tator is upfront about the project’s selection research bias; that the autopsied organs came from players with evident and significant neurological declines. Healthy brains are also needed. High on Tator’s project wish list is to compile a bank of 100 athletes’ brains “when they’re done with them.”

Ezerins has pledged his brain. So has Elberg. Dunigan was one of the first.

More from The Star & Partners

LOADING

Copyright owned or licensed by Toronto Star Newspapers Limited. All rights reserved. Republication or distribution of this content is expressly prohibited without the prior written consent of Toronto Star Newspapers Limited and/or its licensors. To order copies of Toronto Star articles, please go to: www.TorontoStarReprints.com